Book reviews

Edwin Wolf 2nd, distinguished Librarian of the Library Company of Philadelphia, presents a rich collection of Philadelphia lore and iconographic treasures in Philadelphia: Portrait of an American City. Covering the city's history from 1609 to 1975, Mr. Wolf has drawn from wide reading, research, and personal experience an enormous body of data concerning Philadelphia's people, places, objects and events. Six hundred pictures, 135 in color, illustrate his text, in drawings, water colors, etchings, engravings, lithographs, paintings and photographs, including, among many others, works of Benjamin West, Edward Hicks, Gilbert Stuart, William and Thomas Birch, Charles Willson Peale, Peter Rothermel, David J. Kennedy and Thomas Eakins. The book has been handsomely produced. Described as "a Bicentennial history " it is a welcome addition to the many volumes celebrating the nation's 200th birthday. Mr. Wolf loves his city and knows it well. He proudly describes the many strengths and accomplishments of Philadelphia, but he also freely states and graphically illustrates its weaknesses. The city has been guilty of smugness, lethargy, bigotry, violence and corruption. It has also had its periods of dynamic leadership and innovation in politics, economics, social, religious, artistic and intellectual development. As befits a Bicentennial volume, Philadelphia: Portrait of an American City accentuates the positive. The city has led the nation in many fields of achievement in the past; it maintains its public and private excellence in the present; it gives realistic promise of future progress. All Philadelphia buffs will delight in Mr. Wolf's book. It will prove most rewarding, however, to the general public for which it was designed. Experts will marvel at the amount of information crammed into the text. Indeed, one must question whether there may not be therein an embarrassment of riches. The very wealth of data presented in some paragraphs in a series of factual statements sometimes obscures the narrative line. Each chapter of the book, dealing with a stated chronological period, begins with several pages of text ably summarizing the main developments of that period, with a few pertinent illustrations. Several pages composed predominantly of illustrations follow, accompanied by an italicized text. All of the material is interesting and well chosen, but one wonders if a single text composed of generalizations, immediately illustrated verbally

Had Mr. Barlow confined himself to a plain, unvarnished tale of the results of his practice, whether in pure surgery or obstetrical medicine, we doubt not but that his book would have been received with unalloyed gladness. As it is, we fear there will be many readers who will object to the dogmatic and elementary exposition of surgical or obstetrical principles* with which his facts are encumbered ; while others will reject the facts themselves, merely because they are brought forward as the sequelae of pedantic demonstrations.
We can conceive that a country practitioner, like Hay, who invented or improved surgical instruments,?simplified operations,?suggested new modes of treatment in rebel disorders,? may be listened to attentively, and be looked up to as an authority, whenever he embodies the fruit of his long experience in a series of rules, or in a book of elementary principles. Such a book will always be considered as a work of reference, in cases of doubt; and one in which professional information, whether of a general or a private character, will be sought for. But Mr. Barlow is placed in very different circumstances. The profession know only of his having related a case of Caesarean operation, successfully performed by himself, which, at the time, gave rise to much sceptical discussion. Nor is it likely that, 304 . Critical Analysis. upon such slender claims to popularity, surgeons, whether young or old, will take up his present essays with an expectation of deriving, from a perusal of them, that generic kind of knowledge which is to be found in the more classical and richly-laden pages of a metropolitan surgeon, whose opportunities for the improvement of his profession and the generalization of facts, are only equalled by the eagerness with which he avails himself of them for the interest of others.
Mr. Barlow, therefore, we apprehend, did not judge rightly in suffering himself to be induced to enter into long eiementary discussions, or anatomical descriptions, (which, at most, are but superficial,) respecting points of surgery and obstetricism ; the history, nature, and treatment of which are already familiar to the profession. He ought to have confined himself to a plain statement of those facts he had himself observed in his practice, and he would have then presented us with, we have no doubt, much valuable and practical information.
But, even fashioned as it is at present, the volume before us embraces much that is worthy of perusal; and we, therefore, proceed to give an analysis of its contents, ft is amusing to see how early propensities will, sometimes, induce us to invert the natural order of things. Whenever Mr. Barlow has occasion to associate the two words medicine and surgery, he has invariably assigned the first place to the latter. He, moreover, talks of the philosophy of surgery ! For all these singularities of Mr. Barlow, there is, however, a very ample excuse, alledged by the author himself, who observes, that he has " frequently lamented that, when his professional career began, the 6ame requisitions, were not enforced, and, of course, the same advantages of scientific instruction were not generally professed ; and the locality of his situation has also deprived him of these professional advantages." (p. vi. and vii.) The requisitions here alluded to, Mr. Barlow has previously told us, are those enacted by late legislative arrangements; by which, we presume he means the Apothecary's Act, which renders it imperative, now-a-days, on any one desirous of entering the medical profession, to study medicine before he practises it; a law which did not obtain when Mr. Barlow began his career. This is perfectly ingenuous.
But, although education may have been deficient, zeal, industry, and attention, have not been wanting to make up for it. Mr. Barlow has been in the habit of committing to writing the result of his inquiries ; and it is to this praise-worthy practice that we are indebted for the volume we have now brought before our readers. " From a variety of papers he has selected such as have excited, on his part, the greatest degree of attention; and, though some of th'6 essays were communicated by the author to the periodical journals, in the early part of his practice, yet time and experience have suggested those improvements and corrections, which have enabled him to en* large considerably his original communications. He trusts that what he has published will be received with that liberality and candour which are the best ornaments of professional excellence. He has no wish to disarm the severity of criticism by acknowledgments or professions, because he makes no pretensions beyond such as are founded on a sincere desire to advance the interests of surgical science, and to facilitate the operations of surgical skill." (p. vii. and viii.) The first part of Mr. Barlow's volume is dedicated to the consideration of some diseases of the urinary organs. This is preceded by some general observations, in which the study of the structure of the pelvis, and functions of its connected viscera, is strongly recommended. Some of the affections of the prostate are slightly alluded to ; and, among the causes of this last class of diseases of the urinary apparatus, Mr. Barlow mentions " high living, constipation of the bowels, and excessive sexual intercourse." We do not profess to understand, and, if we did, we could not acquiesce in, the explanation proposed by our author of the formation of calculi.
il When there exists in the constitution a predisposition to the formation of calculi, portions of gravel, which pass from the ureters, are retained in the cavity of this receptacle till a nucleus is formed; and this may be one way in which calculi are primarily produced, and eventually become increased to a size too large to pass through the urethra naturally. Thus one disease frequently tends to aggravate another, and, in this instance, a retention of urine at intervals occurs: hence the aid of the catheter is required as a means of affording tempo, rary relief to the patient." In cases of pain or irritation of the bladder, whether from the presence of calculi or some morbid affection of its coats, accompanied by an irresistible solicitation to urine, and a painful sensation in the glans penis or neck of the bladder, Mr. Barlow has used, with great success, an injection, consisting of a solution of opium, or an infusion of the leaves of belladonna, and mucilage of gum arabic, in tepid water, into the bladder. Sometimes the passing of a bougie, though there be no stricture S06 Critical Analysis? of obstruction in the catheter, Mr. Barlow says that he usually plugs up the eyes of the instrument with wax, before its introduction, in the expectation that the latter will melt, or that it will be forced out by blowing into the catheter, and thus the urine made to flow without interruption* This is both new and ingenious. There are only two difficulties to its execution: the first, that wax will not melt at the temperature usually found in the urethra, especially as moisture is present; and the second, that where the urethra itself is stated to be so surcharged with blood that the eyes of the catheter are plugged up with them, when an attempt is made to introduce it?there will be no room for blowing out the said wax. Mr. Barlow, therefore, must give us a better explanation ot his success in these cases. Every surgeon prides himself in possessing a certain degree of dexterity with regard to the introduction of the catheter. Mr. Barlow is not deficient in this sort of feeling ; and our readers will learn from himself how readily he can perform that operation, where other practitioners have failed. " Retention, or a defect in the evacuation of the arine, is always a serious disease, and may be produced by a variety of causes ; such as, mechanical or morbid obstructions of the urethra, prostate glaud, or inflammation of the bladder; for, when this receptacle becomes extensively distended for a length of time, it loses its power of contraction, and, unless relieved by the catheter in due time, the urine becomes acrid, and inflammation and mortification are the consequences. This calamity is more frequently incidental to the advanced state of life, and its morbid effects are, in some degree, counterbalanced by the system being less susceptible of irritation and stimuli than at an earlier period. I have known many old men retain their urine, with compa. rative impunity, for the space of two of three days; and in one instance a gentleman, by whom I was consulted, was six days and nights without voiding any urine. During the whole of that period, the catheter and other means had been fruitlessly employed by two medical attendants, who considered the disease to be a suppression of the secretion of urine. In this case, instantly and without difficulty, I passed the catheter into the bladder, and evacuated more than three quarts of turbid offensive urine ; and, on passing the finger up the rectum, I discovered an enlarged prostate gland, which induced me to leave a flexible catheter, with a small cali's.bladder affixed to it in this viscus, through which the urine was permitted to pass off ad libitum. The instrument was taken out and cleaned occasionally, at which times I could distinctly fed a calculus with its point; and, after the lapse of a few weeks, the organ resumed its natural functions. The inflammatory symptoms having subsided, 1 became anxious to as. certain the natural power of the bladder; for which purpose the catheter was left out, and in a few hours the gentleman was seized with excruciating pains about the neck of the bladder. On attempting to pass the instrument) 1 perceived the calculus had got into the urethra, Mr. Barlow's Essays oh Surgery and Midwifery. 307 which led me to pass the finger up the rectum, with which I pressed the calculus forwards, whilst the point of the catheter served to dis* tend the passage. In this manner I extracted a calculus about the size of a horse-bean, and the instrument was replaced in the bladder as before. During this period the gentleman was allowed to walk about; and, though he has since experienced occasional attacks of retention of urine, the same mode of treatment being adopted, his life has been preserved, and he now enjoys a good state of health in the eighty-fifth year of his age. In addition to mechanical aid, these cases require a strict attention to the antiphlogistic course, according to the age and condition of the patient. If there be a full quick pulse, with flushings of the face, and much fever, general as well as local, bleeding will be proper; such as cupping from the pubis or perineum." (p. 20?22.) The second and third point connected with the diseases of the urinary organs, respecting which Mr. Barlow has favoured us with the result of his experience, are the method of sounding for the stone, and a knowledge of the symptoms of its presence in the bladder. i <? To acquire an accurate diagnosis of the presence of stone in the bladder," observes the author, " it is proper to question the patient respecting the primary symptoms: whether they originated in the kidneys, or in the bladder; whether small calculi, or sabulous depositions, have been observed in the urine; and whether there be any cause to suspect an hereditary diathesis.
" The symptoms usually accompanying stone in the bladder are gradually developed, and may be included in the following statement: (< A sense of weight and uneasiness felt about the neck of the blad.
der, and pressure at the rectum, particularly when the patient moves about.
"An irresistible propensity to a frequent expulsion of the urine, although the bladder may have been emptied not long before, especially when in an ercct position, along with a smarting, burning, or pricking sensation at the extremity of the penis, which causes the patient to walk in a creeping straddling manner ; with an almost inces. sant desire to go to stool. The urine, in the incipient stage, is almost always clear; but, as the disease advances, it becomes turbid, caused by repeated attacks of inflammation, which produce ulceration, and a secretion of coagulable lymph from the inner surface of the bladder. Eventually, pus is perceived to be blended with the urine, and streaks of blood, more or less as the surface of the calculus is rough or smooth; and, during the progress of the disease, the desire to pass urine becomes more and more frequent, till, at length, the bladder loses its usual power of distension, hectic fever ensues, and the patient sinks under the disease, unless the stone be removed. " Great pain at the glans penis on ejecting the last drop of urine, connected at other times with tenesmus, more particularly in young persons; an intolerable itching irritation about the external orifice of the urethra, attended with frequent involuntary erections of the penis* Which part the patient is induced to nip with his fingers, to relieve the 3 3015 Critical Jlnaljjsis. paroxysms, while the prepuce becomes elongated, and sometimes nearly closed, are also among the symptoms of this disease. 44 In some instances, the sufferer is free from pain for a certain time, and a considerable quantity of urine will be collected in the bladder, which, on evacuation pleno rivo, is suddenly stopped; but, on the patient varying the position of his body, the calculus recedes from the neck of the bladder, and the urine flows again freely as before.
*' In the advanced stage of the disease, the urine deposits a sabulous and turbid sediment, with an offensive smell. On some occasions, the abdominal muscles become affected with spasm, and the patient is seized with fits of shivering, accompanied with a discharge of mucus along with the urine, which indicates inflammation of the coats of the bladder: under these circumstances the operation is inadmissible. 44 Difficulty of retaining the urine, with dribbling resembling slillicidium urinae, and, at intervals, urgent efforts to expel the contents of Ihe bladder, caused either by a change in the situation of the stone, position of the body of the patient, or the coats of the bladder being 110 longer protected by the intervention of the urine. During these efforts the difficulty becomes greater, and the pain aggravated. 44 Haemorrhoids in the decline of life, and prolapsus ani in children, are frequent attendants on the disease, together with occasional retraction and atrophy of the testicles. " When small calculi become lodged in the ducts of the prostate gland, there is usually some difficulty in voiding the urine, attended with pain about the neck of the bladder, and a sense of uneasiness at the glans penis, not very dissimilar to that produced by a stone in the cavity of the bladder; in which case, the surgeon should aid the researches of the sound, by passing the finger up the rectum, in order to acquire a more correct diagnostic of the nature of the case.'' (p. 32 ?34.) But even the assemblage of all the above indications may unwarily mislead the surgeon, unless he should, at the same time,, have recourse to the assistance of the sound, ere he decides on the case.
Mr. Barlow then proceeds to tell us what a sound is, and how it should be used; precisely as if the profession were but little informed on either of those subjects. He likewise proposes an improved instrument of that name, which he has reduced to about one-half of the usual thickness or diameter, on the supposition that its motion, in passing down the canal of the urethra, will thereby be greatly facilitated.
Mr. Barlow has also favoured us with details of his method of introducing the sound in the male subject, which, he observes, jiiay be done when the patient is standing, sitting, or lying. mor of the nose, as they have appeared before in this-Journal and other publications.
The second half of Mr. Barlow's volume, as we have already observed, is on subjects connected with midwifery. The papers, of which this part is composed, are partly new and partly reprinted from periodical Journals. Of the latter description are, 1, his Inquiry into the'various Opinions advanced by Writers on Midwifery, respecting the Management of the Placenta; 2, on the Advantages and Disadvantages of inducing Premature Labour, with a view of superseding Embryulcia, the Section of the Symphysis Pubis, and the Caesarean Operation; and, 3, Observations on Delivery in difficult Cases of the Pre-,sentation of the Shoulder of the Fetus, and where one or both Arms present along with the Head. ( The public have long ago decided on the intrinsic value of the doctrines contained in these essays; nor are we disposed to disturb their verdict. It should, however, be observed, that considerable additions have been made by the author to each, and especially to the first, of the above-mentioned essays. We heartily agree with Mr. Barlow in the rules he has laid down for the removal of the placenta, in cases where it does not follow the delivery of the child in the spaee of from one to two hours; and also where a profuse hemorrhage takes place on the delivery of the child, and continues without restraint before the exit of the after-birth. There is no room for temporizing in either case; and the idea of leaving the management of the placenta, wholly, to nature, is perfectly absurd, not to say mis* chievpus.
Under the head of distorted pelvis, we find the following synoptical table, exhibiting, at one view, every possible deviation betwixt the natural dimensions and the greatest degree of distortion. Mr. Barlow has again brought forward his successful case of Csesarean operation, with which the medical profession are well acquainted. To it he has added two other cases, in which he performed the same operation, though not with equal success. The history of the latter case, though long, we must insert in this place, as an instructive lesson to practitioners in midwifery. We have no hesitation in asserting, that the delivery of the child can be effected, with the assistance of the perforator, where the anterio-posterior diameter is ]|, as it appears to have been in Mr. Barlow's case. We have, on a former occasion, brought forward a case in point, where a diameter of 1 fproved no impediment to the delivery of a large child, after cephalotomy had been performed.* At the same time, we do not mean to condemn Mr. Barlow for having had recourse to the Csesarean section in his case, where he had a conviction of the child being alive; but he should have determined upon performing it sooner. <c The following case of Caesarean operation occurred to Mr. Dugdale, surgeon, of Blackburn, by whom I was callcd in consulta-tion^ the history of which I will give in his own words.
" 'Early on Friday morning, April 6th, 1821, I was desired to visit the wife of George llidgedale, in the 42d year of her age, and in labour of her ? child at the full period of gestation.
ii 'Her general health, I was informed by Mr. Barlow, who had attended her in several of her preceding labours, had suffered much for the last two or three years, during which period she had become much reduced in stature; and had not, for some months past, been able to walk without assistance, owing to a state of general debility of the system, induced by an anasarcous affection of both legs, and a state of malacosteon of the bones of the pelvis. " 'On my arrival, I was informed that she had had uterine pains upwards of twelve hours, which now recurred at regular periods every ten minutes.
" 'On examination per vaginam, I found the os uteri dilated to near the extent of half.a.crown, the membranes protruding into the vagina; but could not feel the presenting part of the child.
'At 6 o'clock p.m. her pains returned more frequently; the os uteri appeared, to the touch, somewhat more dilated than on my for. mer visit, and the membranes so filled the vagina as rendered it ha. zardous to reach the brim of the pelvis without rupturing them. t( 'At 9 o'clock f.m. the pains were unabated iu frequency; but the membranes, on examination, were so flaccid during the interim of the action of the uterus, that I determined to rupture them, which was done by introducing my hand within the vagina; and I found the head of the child presenting at the brim of the pelvis, and resting on the edge of the pubis : it was moveable, and easily receded out of the reach by pressure with the point of the finger. 312 Critical Analysis.
'"The projection of the sacrum and lumbar vertebras into the cavity of the pelvis, together with the pendulous state of the abdomen, reni. dered it wholly impossible for the head to enter the brim of that aperture. 44 'After rupturing the membranes, the pains relumed every five minutes, and, on waiting an hour, I repeated my examination; but, finding the head not advanced, And considering her life in great danger, I -thought of introducing the perforator, with the view of opening the head, and lessening its bulk by evacuating the brain. To this I was induced on reflecting that, in this species of diseased affection of the pelvis, the bones frequently yield, and allow the head to pass with greater freedom ; which circumstance, I was since informed by Mr. JBarlow, had occurred in two or three of her preceding labours. But, on passing the perforator up the vagina uteri, and on making the least pressure on the scalp with the point of the instrument, the head receded beyond the reach of the finger; and this project was, of course, abandoned.
" Barlow, about half-past three o'clock a,m., performed the operation in the following manner: " 'The woman being laid on a bed in a horizontal position, with the head and shoulders a little raised by pillows, he commenced by making a longitudinal incision seven inches in length, beginning three inches above the umbilicus and two inches on the left side, carefully cutting through the muscles of the abdomen in a line parallel to the linea alba ; by which the uterus came in view, and appeared in close contact with the abdominal parietes through the whole extent of the wound, from which a small quantity of serous fluid escaped.
" 'A corresponding incision was then made through the parietes of the uterus, which did not equal the edge of a shilling in thickness in any part, and to which the placenta lirmly adhered throughout. In ponsequence of this attachment, it was thought prudent, rather than expose the woman to hemorrhage by detaching the placenta from the uterus, to continue the incision directly through its substance ; which was soon effected, and the nates of the child exposed to view. The babe was then extracted alive, and, on the umbilical cord being tied and divided, was handed to a female assistant.
" 'The placenta and membrane were then brought away; and, during the contraction of the uterus, the bowels protruded at the wound, but were soon returned into their natural situation, and preserved there, while the incised integuments of the abdomen were dosed together by means of the interrupted suture, about the space of an inch from each other, and secured with stripes of adhesive plaster, and pledgets of lint applied over, and a roller passed a few times round the body in the form of the T bandage.
" 'During the operation, and before the wound was closed, there was a quantity of blood discharged from the vessels of the uterus, which might probably amount to ten or twelve ounces. " 'The woman never complained during the operation, nor seemed disposed to syncope. She was now removed, and laid in bed, and appeared much fatigued and sickly. " 'April 7th, 7 o'clock a.m.?Pulse 120 in the minute; pain of the abdomen; slight discharge per vaginam ; with nausea and inclination to vomit.?R. Tinct. Opij, gutt. xx. " 'At 9 a.m. pains and nausea abated, pulse 120. Eleven o'clock a.m. pulse 130; tongue a little furred and dry; has very little pain, sickness, or retching. " 'Not having made water since the operation, the catheter was in.
troduced, and about a pint of urine drawn off. <{ ^JEight hours aftpr death, the abdomen appeared much distended* I obtained leave to evacuate its contents, with the intention of examining ijie state of Jhe viscera and pelvis; but was preventpd from making ftt/fsorrect.an inspection as I couid have wished, owing to the inter, option of some of her friends. " 'Th,e incised edges of the integuments of the abdomen had not adhered in any part. *MOn removing the sutures and enlarging the opening, a small qjua,nt^y of limpi^ fluifl passed off, similar to what Was discharged during the operation. 'The stomach appeared much distended, from which near three quarts of dark-t?ljou'jed liquid was evacuated.
" 'The liver was sma^l and light-coloured.
. u ?The intestines presented no appearance of inflammation. . 44 'The uterus seemed free from inflammation, except a slight degree round the edge of the wound. The incision of this organ was contracted to about 2? inches in extent; and its volume seemed of the usual bulk at the same ppriod after delivery in the natural way, ti' 'The dimensions of the pelvis were as follows: " 'The conjugate or anteroposterior diameter, from the symphysis pubis to the nearest point of the-sacrum or lumbar vertebra, if inch. i' 'The greatest space to be gained on the right side of the brim of the pelvis, 2 inches and near |; viz. from the anterior part of the acetabulum to the projecting part of the sacrum. ' " 'The greatest distance to be obtained on the left side, between the corresponding points of the right aperture, lj inch. " 'The difference between the diameter of the two sides of the superior aperture^ is manifested by the last lumbar vertebra projecting inwards, and forming a considerable curve in the cavity of the pelvis, induced by a state of malacostcon, which opposed the chief obstacle to embryulcia." Had Dr. Ralph Palin had any other christian-nafne than the one which appears on the title-page of his book, we should have proclaimed him either a native of the Gallic shores, or an inhabitant of a petty republic contiguous to the Jura. His ideas, not to mention his language, are exotic ; and, if he be really an Englishman, then his residence on the continent has, in soma? respects, exerted a revolutionizing influence over his habits and manners.
We only know of one other book in an English dress, which) for the importance of the title,?the obscurity of its language,?and the inutility of its conclusions, cah be compared to the present volume; and that is' Madame de Stae?'s Treatise on thelnfluence of the Passions, translated into English. We recollect, several years ago, rising from our cjesk, after having pored over her octaVo for sundry hours, with a sensation of oppressive confusion in our head quite distressing, which, as it gradually yanighed, on a due exposure, to cool air, left a perfect blank on the tablets of our memory, as to wfyat we had been reading.
Dr. Palin's booH was laid on our table on the 22d of the, month; and, although we do not profess to be friendly to disquisitions bordering on metaphysics, we were so caught by thetitle, that we soon got through its closely-printed pages ; and this day, being the 23d instant, we sit down to give au impartial account of its contents.
It seems to be one of the objects of Dr. Palin to demonstrate a well-known truism, that the character and disposition of youth, whether in the moral or in the physical order, depend piore on the early impressions received from parents, than on, any subsequent ones which may be communicated by after circumstances. Dr. Palin adds this remark,, that the female youth is more particularly liable to the above observation} sq t;hat the character of their constitution and temperament will be found to depend much more on the management pf the early period qf life, than of any more advanced one.
ft By the early period here is meant that progresgi?e stage, which precedes the full developing of the system; and, apcordipg ^.o the principles which regulate the physical education duxing this progress, the constitution will become ameliorated, or otherwise, and thp yfhole (rain of conservatory movements receive the impressions of strength or weakness." (Preface, p. v. y\.) 316 Critical Analysis. The sort of management, to which the author alludes, constitutes what foreign writers have called " Education physique a subject on which various works have been written abroad, though with very little benefit to mankind. In this country tbe subject of physical education has been wholly neglected ; and, looking on Dr. Palin's work as a first attempt to introduce the consideration of that important subject to the notice of the' English public, we hailed its appearance with satisfaction.
We shall let our author speak for himself, in giving a brief abstract of thq matter contained in his volume. " The two first chapters, which might form the first part, relate to the influence of climate upon the human system, connected with those impressions which attach to it from the action of the great phenomena of nature upon the peculiar phenomena of life, and with those modifications which it produces, under different circumstances, in the female constitution.
" The five subsequent chapters, which might be termed the second part, refer to the influence of artificial habits, as they are diversified by the effects of climate, upon the animal system, and to the modifi. cations we have it in our power to make, according as the principles just mentioned shall direct our management of early life; for artificial manners and habits may have opposite effects, from the manner in which they are regulated: they may support the best views and de* signs of nature, or they may frustrate them. " The eighth chapter, which might form the third part, refers to the consequences which, under our climate, often follow in the female constitution, when the principles, which ought to form the guide of their physical education, give place to others which produce opposite effects." (p. ix. x.) With the subject of the first chapter, and its two sections, we, as medical men, can have but little to do. The first point treated in this book, on which we should arrest our attention, is the consideration of those physical causes which are supposed, by the author, to act in determining the character of the female sex.
We do not think Dr. Palin at all happy in his positions on this head.
1. Of the disposition which the female system acquires in the progress of its development.?From the little activity, says Dr." Palin, given to the muscular and animal system, the nervous organ acquires in females greater mobility, and, by redacting upon the former, renders it far more susceptible, and presents a form of superior sensibility and irritability. We acknowledge our inability to understand this passage. Females, '* in our climate, and under our domestic institutions, are more arbitral rily submitted to the yoke of artificial laws, which communicate the impressions of debility to the organization, far more frequently than takes place in the other sex." This passage Dr. Palin on the Influence of National Manners, &c. 517 is not much clearer than the former. The corollary which seems intended to follow whatever doctrine it was the intention of Dr. Palin to incorporate in the above two passages, is contained in the annexed extract.
"It is this circumstance, and this peculiar susceptibility to receire the impressions of organic weakness, under our social habits, which renders the physical education of the female a subject of so much importance. Her constitutional disposition, partaking naturally more ef activity than strength,?more of sensibility than firmness, becomes endued, under our institutions, with a peculiar irritability; which, being more active in early age than at any other period, makes the task of submitting her to their full influence one of great delicacy. In fact, in our subjection of this easily excitable frame to the laws of artificial life, we should be constantly guided by the indications of nature, as they appear manifested in the economy of the system. But atten. fion to this subject becomes of greater importance, in proportion as the unfavourable effects of climate exercise a correspondent influence over the habits and manners of life, in producing an ungenial re-action of these upon the physical constitution. These effects, according to the preceding observations, will operate more in countries of a low temperature than the reverse. It seems, in fact, that, in contradiction to the common opinion, the stamina of females are more feeble in cold than in hot climates, as their muscular fibre is less firm and dense; and that the idea so usually entertained of the action of the former in strengthening the powers of life, is often erroneous, since the effects of that action are relative to habits. Cold, by the re-action it produces, and by the vigorous exercise it promotes, may be one source of strengthening the powers and developing the energies of the male, who lives in the open air and is engaged in active pursuits ; but it has, usually, a very different influence upon females, when joined to the confinement and artificial temperature in which it obliges them to take refuge; and hence the influence of some climates upon the different sexes proves, in many respects, extremely opposite." (p. 36?38.) 2. Of the causes which make climate and temperature act with a varied influence upon the different sexes.?Dr. Palin is of opinion that the nature of the English climate is unfavourable to the female sex ; for the confinement and seclusion which it renders necessary, has, on the female constitution, the most pernicious effects. To the absence of any such necessity in southern latitudes, must be attributed, principally, not only that firmness of fibre and physical energy, but those personal advantages which belong, in a superior degree, to the females of warm climates ; for, with respect to beauty and expression of feature, and form of person, we must allow them to be greatly in favour of the inhabitants of the South. *( It were vain to look in the German nations, or amongst their northern neighbours, cither for that firm texture of flesh, which is peculiar to the truly fine form, or for that expressive cast of feature or 3 IS Critical Analysis. elegant mould of liuib, which are common to the more southern fe-. males. The women of several parts of Germany, particularly the Saxons, display a fine complexion and beautiful bloom, but their light hair and fair skin are emblems of their debility; nor does the texture' of the fibre prove greater strength. What a contrast do we find between the firmness of the flesh of the Italian and Spanish women, and the looseness and flaccidity of that of the Dutch, whose forms are al. most uniformly weak and nervous, and have so languid a circulation, that artificial means are constantly employed to keep warm the feet! The same contrast exists, in a greater or less degree, between the female inhabitants of other climates, where there is equal diversity of temperature." (p. 42,43.) Our author indulges so often in speculations far above our comprehension, that we cannot attempt to follow him throughout his book. What seems to be the most important consideration respecting the general education of females, which Dr.
Palin is desirous to impress on his readers in the two first chapn ters of his work, is that of the dy.e regulation of the impressions, arising from five causes : education in females under the influence of our domestic institutions.
We now pass on to the consideration of the effects which exercise and air have upon the muscular and animal system in females, at this early period of life, which Dr. Palin has dilated upon in the two sections of the fourth chapter. The females of the better classes in Etigland suffer very considerably from a morbid susceptibility to atmospherical impressions, to which the confinement they suffer renders them peculiarly liable. Hence one of the most important points of their physical education, is that which -relates to the strengthening of the constitutional energies, in increasing their power of resistance to those effects which arise from the unfavourable influence of the climate* 44 We know that the most remarkable effect of habit, is to diminish gradually the sensibility of the organs; and that an habitual exposure to atmospherical vicissitudes produces this result in the. most salutary degree. To this object, therefore, should the attention be particularlydirected in the management of female life; for, in proportion as it is attained, the action of the functions will be more complete, and health and vigour be infused into the system." (p. 86.) The same observation, but perhaps with greater forcej may be made with regard to exercise. 320 Critical Analytic. moral attributes arise those dispositions, tastes, and habits, which distinguish females from the other sex. The contexture of all their organs is more delicate, and their primitive constitutional dispositions are continually renewed, as it were, by the operations of their sensibility." (p. 86", 87.) " The mode of exercise indicated in different subjects, whether of an active or passive kind, must, even in the period of youth, depend frequently on circumstances referrible to the constitution and habit; but, in a state of health, the former will generally be most congenial to the young. This will be necessarily, in many cases, an important consideration; because the effects of active and passive exercise, on the circulation,?on the secretions and exhalations,? on the digestive and respiratory organs, are very different. In fact, exercise, whether considered only as a source of amusement, or as a necessary part of the regimen of health, must, in order to answer either view, hold some relation to the ordinary habits and manners of life, as well as to age and constitution. An airing in a carriage, for example, though an excellent exercise for them whose minds and bodies have experienced the fatigue of previous occupation, and for the generality of adult females ; will answer the preceding indications in a very inadequate manner in the case of the young, in whom all the muscles of volition are peculiarly disposed to action, from that excess of vitality natural to youth. It is then that the muscular and active exercises are more agreeable to the whole constitution of life, and that the expansion of ihe various powers and processes of vitality appears greatly to depend iipon their employment." (p. 94? 95.) ... The transition from the consideration of exercise and air on the development of the muscular system in females, to that of the effects of particular aliments on the animal fibre, is perfectly natural. To the latter, then, are we lead in succession by our author.
Regimen is not an unimportant part of the science of life; since, under its influence, we see organized bodies become so variously and so profoundly modified in their internal parts, as to lose those dispositions they had received from original conformation, and acquire a susceptibility to new impressions and new habits, which relate not only to the physical functions, but to the moral and intellectual ones. The consideration, therefore, of the subject of diet may be placed under two points of view; the first relating to the effects it produces on the muscular and organic systems; the second regarding the same effects produced on the nerves.
Dr. Palin lays down some general, as well as specific, rules with regard to the admission of a certain quantity of stimulus (food) into the stomach.
In speaking of vegetable diet, our author has advanced some ingenious arguments against its supporters, whom he supposes to recommend vegetable, in lieu of animal food, as Br. Palin on the Influence of National Manners, Sue. 321 containing less stimulating matter, and furnishing the principal part of the nutriment employed in a state of nature.
3.$$ Critical Analysis. vegetable diet, that it is a return to nature, can by no means apply under the artificial race of vegetables which horticulture has created in our northernly climate." (p. 127?129.) The question respecting diet, as far as concerns our species, seems not to be what particular aliment the natural conformation of our organs qualifies us originally to take, but what best suits the different circumstances of life, under the great and peculiar changes it undergoes in the various modifications it assumes.
Hence, though the question as to what was the particular food destined by nature for mankind, may be a point for agreeable or profound speculation, it can scarcely be deemed one of such great practical utility as some would persuade us ; and perhaps, impartially pursued, it would bring us to theconclusion of Daubenton, that man has no natural food.
In the physical education of females, the choice of diet must hare some relation to those diseases to which the delicate state of their organs render them most susceptible. Climate not only modifies the properties of many articles of aliment, by the action rt produces in their constituent parts, but varies the degree of adaptation on the part of the organs to their impression. But the influence of climate, which it behoves us most to be observant of, is the general determination it sometimes manifests in infusing the propensity to particular trains of diseases; and the effects of regimen, which it is equally most important to study, are those which operate to counteract similar propensities. Now, the prominent morbid action of the atmospherical phenomena we experience, seems to be that which disposes, almost uniformly, to the diseases of debility; in correcting the predisposition to which, a proper regimen, employed sufficiently early, may have great influence as a preventative. Such constitutional debility is the primary source of every species of scrofulous affection; whether connected with a morbid irritability, exciting particular parts, or with a general torpor extending through the whole frame, and connected with a deranged and altered state of the glandular organs. The same constitutional delicacy disposes to pulmonary consumption, in endowing the internal membrane of the lungs with a too-great susceptibility to certain agents, on the operation of which depends the development of disease. This debilitated condition of the living fibre, leading to a diseased action, is totally independent, however, of any acrimonious impregnation either of solids or fluids; and therefore in females, whose early tendencies lead to well-grounded apprehensions of some future visitation from complaints of a similar character, preventive measures cannot begin too soon.
Their success indeed will depend, in great measure, on that part of physical education which relates to the dietetic plan, and on the proper adaptation of regimen to early indications and latent dispositions." (p. 136?138.) > Dr. Palin examines three different temperaments whic|i females are mare apt to exhibit, and to each he appropriates a particular sort of diet and a specific regimen. This subdivision Dr. Palin on the Influence of National Manners, Kc. 323 is., to say the most of it, ingenious. In practice, all these distinctions vanish; and we often find that a female, possessing a temperament marked by decreased irritability, cannot well be managed without a diet which Dr. Palin has assigned to females of a highly nervous disposition. As for his observations on the effect of certain diet on the nervous system and the morals and happiness of the social order, they are, by far, too metaphysical to be noticed in a medical review. Indeed, we fear that our readers are already disposed to find fault with us for dilating at such length on a performance, from which we have not been able to .cull any very useful practical precepts, applicable to the purposes of life, that had not already been very often proclaimed by preceding writers. We must, therefore, hasten 011 to the conclusion, simply enumerating the remaining subjects, on which Dr. Palin's pen has touched with equal felicity.
The first of these is the sympathy between the animal and intellectual system, and the influence of the action of the former in allaying the irritability of the last.
Next we have some observations on the manner in which, from the sympathy between the muscular and intellectual system, mental excitement may act in allaying corporeal irritability.
In chapter the seventh, the author has undertaken to examine the very important question of clothing, and its relation to health, under different circumstances connected with atmospherical impressions. With regard to the female sex in particular, this question is one of great interest. Pectoral congestions, in climates like our own, are met with more frequently than in colder climates, from the chest being oftenerleft exposed to the inclemency of the weather, and from the inadequate attention paid to the external coverings of the body. upon the pleura. For these reasons, probably, the pleura is moreliable to inflammation than other membranes investing cavities which have no external opening. This is so much the case, that one can hardly examine the chest of any person who has arrived at the adult state, without perceiving more or less the traces of a present or former inflammation." (p. 226?227.) There can be no doubt that diseases connected with consumption, the origin of which is congenital, may remain latent through a long life, or be brought early into fatal activity, by a greater or lesser degree of that attention which regulates the external covering of the body, and establishes the healthy condition of the skin.
To regulate, therefore, the effects of atmospherical impression on the female constitution, Dr. Palin proposes, 1st, that We should direct our efforts towards lessening, as far as possible, the susceptibility of the habit to atmospherical impressions; and, 2dly, that we should guard against them by proper coverings.
The terminating chapter of Dr. Palin's work involves matters of practical importance, which he has treated in a very able manner, and to which we must refer our readers, certain that they shall find what will repay them for their pains. We more particularly allude to his observations on the scrofulous diathesis and temperament, and on the consumptive tendency in early life.
In characterizing the performance before us, we should say, that the language of it is frequently obscure, and that the author's meaning is not always clearly defined. There are innumerable repetitions in the body of the work, and an everrecurring strain of metaphysical ratiocination, which we should not have expected in a modern book on the physical education of females; for, whatever Dr. Ralph Palin may say, or the admirers of his system repeat, the wearing very tight stays, and a long waist, may injure the digestive organs of a< young female, and make her an old invalid, but will never prevent her becoming a Stael or a Genlis. In every branch of science nothing is so useful as the diversity of opinion, which we frequently find existing among men who have investigated the same subject. It produces doubt in the Mr. White on the Stricture of the Rectum. 325 minds of those who are anxious to attain knowledge; and leads them to receive, with caution, doctrines to which they would otherwise implicitly subscribe, until by their personal enquiries, they are convinced of their orthodoxy. This remark applies to Surgery, as well as to every other department of art and science: and it is the anticipation of the beneficial result of such doubt, as far as regards the subject of the treatise before us, that induces us to lay an analysis of the opinions it supports before our readers.
In his preface, Mr. White states, that the present publication ha? been drawn up for the praise-worthy purpose of preventing young practitioners from being misled by " some representations" contained in the writings of Mr. Charles Bell and Mr. Howship on Strictures of the Rectum, calculated to impress " the minds of the inexperienced with a limited and partial view of the complaint; which, if adopted, would tend to prevent the knowledge of it from extending." Mr. White complains, also, that these authors, although their publications contain " an evident allusion" to some of his remarks, yet have not mentioned his name; an oversight, however, which, we must remark, is by no means peculiar to the accused, nor at all uncommon in the present period.
Mr. White's leading principles are, that stricture of the rectum is not, as has been maintained by other writers, always the effect of inflammation ; and that the inner membrane of the rectum is not the seat of the complaint. His opinion, with regard to the absence of inflammation, he states, to be founded on the following: observations:? , (t The great length of time the disease is frequently known to exist? the slowness of its progress?its limited nature, only occupying a very small portion in the circumference of the intestine?and the inner membrane having been frequently found in a healthy state on dissection." The correctness of our author's conclusions from these premises we shall afterwards examine.
The majority of authors have taught that the disease commonly occurs near the extremity of the gut, or at least within the reach of the finger; but they have not certainly maintained, as our author would imply, that it is not also sometimes situated higher up in the gut. He is more successful in refuting the hasty opinion of Mr. Shaw, that the sacrum offers such an obstacle to the introduction of the bougie " further than six inches into the rectum," as to occasion the error of supposing, that the difficulty is caused by a stricture of the gut. from the most distressing symptoms, by the use of the bougie, wftenr all other means had failed, if no real obstruction had existed in the intestine ?" And to prove that his objections to the commonly received Opinion regarding the seat of the disease are not hypothetical, he adds?
Although I may venture to state, that I have as frequently met with a contracted state of the rectum, towards its lower extremity, under as many diiferent forms as any other practitioner; at the same time it may be observed, had my knowledge of simple stricture de. pendcd on those cases merely which have occurred at the lower extremity of the gut, it would have been extremely limited indeed ; and, in all probability, I should not have seen any reason for deviating from the commonly received opinion. But, it has so happened, that in the course of an extensive practice, very few cases of the simple form of constriction have occurred so low down the rectum as to be within reach of the finger. And I can positively assert, that the disease has been frequently overlooked, when the rectum had been subjected to an examination by the finger only.
" So seldom does simple stricture take place within reach of the finger, that on looking over a list containing one hundred and eighteen cases, I do not recollect meeting with half a dozen, out of that number, that were within reach ; and even these, in all probability, would not bave been discovered by that mode of examination, had not the intea, tine been distended in consequence of a lodgment of fasces immediately above the stricture, or passing through its orifice at the time; by which means the stricture was brought within reach ; and an opportunity was likewise afforded of ascertaining the nature of the constriction." Returning to the consideration of stricture of the rectum, the cause which he has, already, declared is not inflammation, Mr. White gives the following as his theory of the origin of the disease:? " Any cause, therefore, which tends to obstruct the passage of the fasces through the canal, must necessarily excite the fibres of the muscular coat of the intestine to a greater action than ordinary, for the purpose of expelling the fseces; this inordinate action, frequently excited at the narrow part of the canal, will, in all probability, sooner or later, terminate in a permanent spasmodic state of the muscular fibres of that part. How long a permanent contraction of the muscular fibres may continue, before any alteration in the structure of the part takes place, it is impossible to conjecture: perhaps under very favourable circumstances, the disease may not proceed to any other' structural derangement: but, there is too much reason to apprehend, from various cases of dissection, that, in general, disorganization,' sooner of later, takes place ; which consists in a thickening of the coats of the intestine, particularly its muscular coat, probably from ^ \ery gradual deposition of coagujable lymph between its fibres." ? Mr. White on the Stricture of the Rectum.

327
Now we mast confess that we do not exactly comprehend the force of our author's reasoning. We cannot conceive the possibility of any degree of spasmodic contraction of the muscular part taking place, sufficient to occasion a permanent contraction of that part, without the existence of inflammatory action. The ^ery occurrence of spasm implies the presence of an irritating cause, the operation of which on the irritability of the part produces contraction of the muscular fibres ; but this contraction must be necessarily followed by relaxation, whether the cause which induced the contraction be withdrawn or continued to be applied ; for in the first instance the excitement being sufficient only to produce a limited effect, the state it induces must cease, when the impulse which the exciting cause impressed is exhausted ; and in the second the effect of the application of any" inordinate stimulus, to an irritable surface, cannot be maintained by the continued presence of the exciting cause; for the part loses its susceptibility by the habit induced from the continued application of the same stimulus. Inflammation, however, may be produced by powerful and long continued spasmodic contraction in the rectum; and it is easy to conceive that the coagulable lymph, thrown out between the coats of the intestine, will produce such a diminished diameter of the part as would not only prevent the faeces from passing readily through it; but, by the retention of a portion of them, will occasion a preternatural extention of the gut above the stricture ; and thus by an increase of the morbid excitement the stricture will not only become more formidable, but ulceration may follow. Indeed, in every case of stricture, whether of the oesophagus, the rectum, or the urethra, we cannot conceive the existence of a thickening of the lining membrane of the part, and the contraction of the passage consequent upon that thickening, independently of in-, fiammation. So far we are of opinion that our author has not made good his point, on this part of his subject.
Mr. White next combats the opinion of Mr. Howship that the contraction of the sphincter ani, which is sometimes accompanied by fissure, is the consequence of a venereal taint: and he observes that the contraction " which is sometimes found at ? the anus as a consequence of venereal infection, differs materially from spasmodic contraction, in being always attended with more or less structural derangement." We admit the distinct character of the two diseases, but not from the circumstance which our author points out as the characteristic feature of the venereal constriction; for we cannot form any idea of fissure of the sphincter existing without the presence of structural derangement. Our author expresses much surprise that neither Mr. Charles Bell nor Mr. Howship have noticed Mr.
Boyer's observations on this form of the complaint; and, to 32S Critical Analysis, make tip for the deficiency of these writers, he has translated a very considerable portion of the memoir of that celebrated surgeon. For the benefit of such of our readers as may not have an opportunity of seeing either the original* of Mr.
White's translation, \Ve quote that part of the translation which desfcribes the method of operating which Mr. JBoyer has successfully employed for the cure of constriction of the sphincter, with or without fissure.
"Now for the manuer in which I perforin the operation?the patient takes three days before a mild purgative, and the same day a laxative enema to evacuate the intestinal canal, in order that the patient may remain some days without being affected by a desire to go to stool. " I make him lie upon his side, as for the operation for fistula in ano; I carry the fore-finger of my left-hand, anointed with cerate, into the rectum, and upon my finger I make a bistoury glide on its fiat side, the blade of which is very narrow, square at the end, and the extremity rouuded off. The edge of the bistoury is then directed towards the right or left side, according to the place which the fissure occupies, and with one incision I divide the intestinal membranes, the sphincters, the cellular tissue, and the integuments of the nates. E thus form a triangular wound, the top of which reaches to the intes. tine, and the base to the skin; it is sometimes necessary to elongate this, I do this with a second cut of the bistoury. In some cases the intestine slips away from the edge of the instrument, and the wound of the cellular tissue extends higher than that of the intestine; we must then introduce the bistoury a sccond time into the rectum to lengthen the incision of the intestine, or complete it with the blunt pointed scissars. 4< When the constriction is great, I make two similar incisions, one to the right and the other to the left; and when the fissure is situated before or behind, 1 do not comprehend it in the incision.
?'?We introduce immediately into the wound, or the two wounds, a large bougie, which prevents the edges of the incised parts from reuniting in an irregular manner. We plug it up slightly with lint, apply a number of pretty long compresses, and the whole is supported by a bandage, like that which is used for fistula in ano. It is seldom that haemorrhage supervenes, a slight compression is always sufficient to stop it. We do not remove the first dressing for three or four days, and afterwards dress it everyday till the cicatrix is entirely formed; this is generally a month or six weeks, in some circumstances the cicatrization has not taken place till after the second month, or in the course of the third ; but at other times, also, in twenty days?once only in fifteen.
<? All the patients on whom I have performed this operation, have bedn cured radically, completely, and without return of the pain of the fissure, or the constriction." * The original will be found in the Journal Comptementaire du Dictionuire de?
Sciences Medicates for November 1818. 4 Mr. White on the Stricture of the Rectum. 329 Our ajithoi* considers the constriction of the sphincter to be, almost in every instance, connected with stricture of the rectum, and, consequently, a secondary affection: and adds, that previous to the publication of the former edition of his observations, he had not (i met with any case that did not yield to the use of the bougie; but two cases have occurred since, where there was a necessity for dividing the sphincter: though," he adds, " I believe this operation will be found very seldom necessary when the bougie is judiciously managed.'' p. 31. Our author, however, admits the importance of the operation introduced by M. Boyer; and we certainly consider it one of the greatest improvements, in the treatment of this variety of stricture, which has been proposed.
Mr. White concludes his remarks by a cursory view of the influence of piles, excrescences, and prolapsus ani, in producing stricture of the rectum; and points out the advantages to be derived from the use of the bougie in haemorrhoidal tumors, when inflammation is not present or has been previously subi. dued. He has lately employed Mr. Arnot's dilator, and delivers the following opinion regarding its applicability as a dis1tending agent in contractions of the rectum.

33#
Critical Analysis'* having been directed to take some curds and whey ; the good effects of Avhich," adds Mr. White, " I had often experienced fn cases of obstinate vomiting." The next four cases, which did not come under the care of our author, are instances of distention of the colon, followed by rupture of the coats of the intestine. The sixth case is one of Stricture with Derangement of the Colon; which was cured by the use of the bougie conjointly with a course of aperient medicines. In these cases our author justly considers the distention of the colon to have been the consequence of stricture of the rectum.
The seventh and eighth cases are instances of Stricture with Spasmodic Constriction of the Sphincter Ani. We shall extract the 6rst of these, as it is illustrative of the beneficial effects of the operation proposed and first performed by M. Boyer, for the relief of this variety of stricture. t M, Tidcomb, aged forty, had been ill about two years. She Complained of having been frequently troubled with a pain about the .pit of the stomach, accompanied by a great sense of heat. She was .often annoyed with distention of the bowels from wind, and experi. enced great difficulty in passing it downward. She was naturally of a costive habit of body, and commonly went three or four days without having an evacuation, and not then unless she took an aperient; but ?even with that assistance the motions were never satisfactory, arid always attended with considerable pain; which continued several hours afterwards, at the extremity of the rectum. She had not passed any solid stools for a great length of time, and when she last observed them to be figured, they were very small and flat. Menstruation was regular but always painful. Her appetite was tolerably good, though some, times she had sickness. She had been under the care of different medical gentlemen without deriving any advantage; but, on consulting Dr. Barlow, he suspected some disease of the rectum, and requested an examination might be made. On attempting to introduce the finger, ' the resistance to its passing was very considerable, from the strong action of the sphincter ani?it was accompanied by a fissure in a line ' with the os coccygis. There was also a stricture a few inches higher up the rectum. , " The patient was directed to take castor-oil every morning?to use a hip-bath daily: and an injection with a few grains of extr. papaveris? a bougie was also employed for some time, but the spasmodic action of the sphincter was so extremely distressing, as to render her incapa> : ble of persevering in its use. In consequencc of which, recourse was bad to dividing the sphicter by the bistoury, in the same manner as directed by M. Boyer. The sphincter was divided on both sides?a day or two afterwards, the evacuations were far less painful in passing, than thqy had been previously to the operation; notwithstanding the soreness of the part. Short tents made of lint covered with soft oint. ment, were employed, until the passages was able to bear the intro. duction of a bougie. The spasms at the sphincter entirely ceased, and the evacuations were discharged without' pain or 'difficulty. In short,